Death and taxes.
The latest round of Lane County government budget cuts may kill a vital local service: death investigations.
Autopsies and signed death certificates also will be casualties, Oregon's deputy state medical examiner for Lane County warned in an e-mail to area health care, mortuary and public safety agencies.
Because of staff cuts, come May 20 there will be no medical death investigators to respond to local reports of accidental, suspicious or unexplained deaths, the deputy medical examiner, forensic pathologist Dr. Dan Davis, wrote in the letter earlier this month.
Without such investigations and a morgue in which to perform autopsies, he will be unable to determine death causes and sign death certificates, he wrote. This will complicate far more deaths than the handful each year investigated because of crashes, homicides or suspected foul play, he and others said.
In a given year, the Lane County Medical Examiner's Office investigates about 1,000 deaths - some merely because the person died of undetermined causes while not under a doctor's care.
Without death certificates, burials and cremations cannot occur, and estates cannot be settled. The investigators' absence will create an "ongoing local disaster" for area hospitals, nursing homes, paramedics, police, mortuaries and "most significantly, the citizens of Lane County," Davis wrote.
Jobs in the medical examiner's office are just a few of the many county government positions slated for cutting this spring in a financial crunch brought on by rising personnel costs and what is likely to be a steep reduction in so-called timber payments from the federal government. Also on the chopping block are lawyers and support staff in the district attorney's office, sheriff's patrols and jail staff, and animal services - although the job eliminations have not yet been carried out and officials are scrambling for alternatives.
Lane County District Attorney Alex Gardner confirmed this week that he has notified two full-time and five part-time medical death investigators that they will lose their jobs after his office stops funding their work effective May 19. Collectively, those employees provide 24/7 response to accidental, homicidal, suspicious or unexplained deaths.
The DA's office also will stop funding the part-time morgue attendant and supplies needed for Davis to perform autopsies in a basement room of Sacred Heart Medical Center, University District.
The cuts would not extend to Davis. Under Oregon law, the state funds medical examiners, while counties are responsible for providing investigators and a morgue, Oregon Medical Examiner Karen Gunson said. If Lane County doesn't meet that responsibility, Davis probably will be reassigned to another part of the state, Gunson said - meaning Lane County agencies would have to transport bodies elsewhere for autopsies.
"Dr. Davis, in and of himself, is not a medical examiner system," Gunson said. "If there's nobody giving him reports and no place for him to do autopsies, why would the state pay to leave him there?"
The axed positions, totaling about $385,000, are part of $2 million in looming cuts to the DA's office because of an expected 25 percent decline in county general fund revenue next year, Gardner said. He plans to cut 17 additional full-time jobs, including eight deputy district attorneys in his office's criminal unit.
The district attorney said the medical investigators and morgue are essential services.
"Losing 25 percent of our general fund support is a death knell to many critical services, and this is one of them," he said, adding that "the sheriff's office and the rest of the system is in collapse, too."
That's true even if Congress agrees to extend timber payments to Lane County for another year, the prosecutor said. Those funds would make up only about one-third of the county's expected deficit.
Examiners have crucial role
Area public safety agencies will meet to try to find a "Band-aid fix" to temporarily ensure timely medical investigations of accidents, homicides or suspicious deaths, Springfield Police Chief Jerry Smith said. Police and medics will face a dilemma when they can no longer call a medical investigator pager 24/7 and summon a death investigator to a crime or accident scene.
"We are prohibited by law from moving a body from a scene until we get authorization from a medical examiner," the longtime chief said. "We're going to be sitting at scenes of deaths for extended periods of time awaiting authorization. I don't know what we're going to do with these bodies."
Local law enforcement also may have a more difficult time investigating crime-related fatalities if autopsies are no longer performed locally, Eugene Police Chief Pete Kerns said.
But both chiefs stressed that crime-related cases are only a small fraction of local deaths requiring investigation each year. Lack of local medical death investigators will complicate matters for loved ones of people who die unexpectedly at home or elsewhere with no foul play involved.
"And (those) citizens are not going to have a fix," Smith said.
Longtime local mortuary owner Mark Musgrove agreed.
"Assume somebody 90 years old dies of a heart attack at home," he said. "When a family member calls us, we normally call a death investigator, tell them what's going on, which doctor had been treating the person, and they investigate. Then the medical examiner will authorize us to move the body. If we don't have anyone to release a body, we can't just take it. What if the person really died of a drug overdose? What if the person was poisoned?"
The implications go beyond the inability to expeditiously remove a body, Smith said.
"If Dr. Davis does not sign death certificates, the resolution of an estate will not occur after a death," the police chief said. "Real estate, retirement, insurance assets - all those things rely on a death certificates."
Davis declined to comment for this article and directed questions to Gardner.
In his letter, Davis wrote that nearly 3,500 county residents die in a typical year. Other doctors can and sometimes do sign death certificates when a patient in their care dies of natural causes in a hospital or other attended setting. But about 1,000 deaths each year are reported to the Lane County Medical Examiner's Office. Davis relies on his county-funded team of two full-time and up to five part-time investigators to help him determine a cause of death.
Those investigators are "the eyes and ears at the (death) scene for the forensic pathologist," state Medical Examiner Gunson said.
The investigators report their findings to Davis, who decides whether the body should go to a funeral home or to the morgue for a medical examination.
After May 19, Lane County will become Oregon's only populous county without "board-certified, full-time medical death investigators," Gunson said. Rural counties use police officers whom her office has trained as death investigators, she added.
Medical death investigations are "one of the basic functions of government," she said.
Almost unheard of
For Lane County, one solution might be to find other public employees to be trained as death investigators - but who might take on that work is unclear.
"Every department is tapped (out)," Lane County Administrator Lianne Richardson said. "We don't have staff to take on additional duties."
Musgrove, former president of the National Funeral Directors Association, said he's never heard of a populous area simply "dismantling" its medical death investigation program.
"There are other systems in other places (such as elected coroners who may not have medical training). But there's always a system in place."
Gardner acknowledged that some of the part-time investigator positions were a bargain for the county. One such investigator, who asked not to be identified, told The Register-Guard she is paid $436 to respond to pager calls for an entire weekend - from 4 p.m. Friday until 7 a.m. Monday. She has investigated as many as 15 deaths during just one such shift, she said.
Davis emphasized that "obvious homicides (resulting from gunshot, sharp force, blunt force, etc.) are actually among the easiest cases" he sees.
The more difficult cases are "apparently non-traumatic deaths in mid-life (involving) complex social and/or medical histories," he wrote. "The most difficult cases are the infant deaths that require the most extensive medical death investigations, the best interpretive skills, and virtually every test resource available."
Getting an answer to the question of why someone suddenly died is "very important to families," Musgrove said. "Not knowing is horrible."
He said many area residents are "up in arms about a proposal to shut down Lane County's animal control agency, but this is going to be more dramatic than that. The sky is falling."
"After someone dies, the family needs to know that their beloved deceased was treated with respect and that their death was thoroughly and appropriately managed. A system that loses all that is not adequate. And we're going to be hearing about it ... It's grim."